Migraine Headaches

A migraine is a severe, painful headache that causes intense throbbing or pulsing in one area of the head. It commonly comes with sensory warnings like tingling in the arms and legs, nausea, vomiting, and increased sound and light sensitivity. Migraines can last for hours or days.

The exact cause of migraines is not currently known, although genetics and environmental factors are thought to play a role. Migraines occur when blood vessels become enlarged and release chemicals that cause swelling and pain. Research into migraines is ongoing.

Wellness & Prevention

A family history of migraines greatly increases a person’s chance of having them. About 90 percent of people with migraines have a family history. Most people get their first migraine during adolescence, though migraines can begin at any age. The majority of people who suffer from migraines have their first episode by age 40. Women are three times more likely to have migraines.

Changes in the environment often trigger a migraine. Some migraine sufferers are able to identify triggers or factors that cause their migraines. Common triggers include:

  • Hormonal changes in women: Menstrual cycle fluctuations, birth control pills, pregnancy, and onset of menopause may trigger migraines.
  • Foods and beverages: Tyramine, a substance found in some foods, can cause migraines. Red wine, aged cheese, smoked fish, chicken livers and figs should be avoided. Nitrate and monosodium glutamate are food additives that can cause migraines. They are in bacon, hot dogs and salami among other foods. The artificial sweetener aspartame, alcohol or large amounts of caffeine can all be triggers.
  • Physical or emotional stress
  • Changes in sleep patterns
  • Allergies to foods or other environmental factors
  • Sensory stimuli: Bright lights, sun glare, loud noises, certain odors or perfumes can be triggers.
  • Changes in weather
  • Medications: Oral contraceptives and some blood pressure medication can aggravate migraines.

Migraines can be complex, with symptoms changing over several hours or days. Migraines typically go through phases, although not everyone goes through each phase. Each person’s experience is different. Migraines can change in frequency or intensity during a person’s lifetime.

Prodromal Phase

Small changes may signal a migraine will happen. From a few hours to a day before, people may have strange sensations. These include:

  • Irritability or depression
  • Hyperactivity
  • Certain food cravings
  • Being thirsty
  • Frequent yawning and sleepiness
  • Increased urination

Aura Phase

About 20 percent of people who suffer from migraines develop an “aura” before their migraine. An aura is a term for nervous system symptoms. The symptoms start slowly and can intensify over several minutes. Symptoms include:

  • Visual problems: Flickering light, jagged arcs of light, vision loss or hallucinations.
  • Sensory changes: Tingling, feelings of “pins and needles,” and numbness of the face and hands. The sensation can spread across the body.
  • Speech and language issues: Difficulty communicating, confusion and problems with concentration.

Auras may not occur with every migraine, and can also occur without a migraine.

Attack Phase

A migraine can last from several hours to several days. During this phase, normal activity may be difficult due to pain. Migraine pain is typically located on one side of the head, but can move from side to side. The pain sometimes affects the lower face or neck. Characteristics of migraine pain include:

  • Begins above the eyes
  • Intense, throbbing
  • Worsens with physical activity

Other symptoms that may occur during a migraine attack are:

  • Nausea and vomiting
  • Sensitivity to light, noises, and sometimes smells
  • Blurred vision
  • Lightheadedness and fainting

Postdromal Phase

The final phase occurs once the headache ends. During this phase, people may feel extremely tired, confused, sluggish or have head pain with sudden activity. Symptoms may last for about a day.

Diagnosis

People with severe migraine headaches may undergo a number of tests. Individual history is studied and neurological exams may be run. Doctors may also run imaging tests such as CT scans or MRIs to rule out the possibility of another underlying health concern.

One way people can help with diagnosis is to keep a diary that tracks health information related to their symptoms. This record can include:

  • When the headache occurred
  • Any symptoms that appeared before the onset of the headache
  • Headache duration
  • Intensity of pain, and anything that made the pain better or worse
  • Possible triggers
  • If you tried taking medications and whether they helped

A doctor will look at medical history as well as any test results to diagnose a migraine.

Treatments

There is currently no cure for migraines. However, a number of treatments have shown to decrease their frequency and intensity:

  • Over-the-counter drugs such as ibuprofen, aspirin and naproxen or prescription drugs like triptan are often used.
  • Antidepressants, muscle relaxants or other drugs may be used preventively. Triptan may be taken at the onset of a migraine to keep it from fully developing.
  • Counseling, progressive muscle relaxation and behavioral therapy can help to control migraines.
  • Massage and physical therapy can help to decrease muscle tension and reduce pain.
  • Acupuncture may be used to decrease migraine frequency and intensity.
  • Chiropractic care may reduce migraine frequency and duration.
  • Home remedies like cold compresses applied to the pain site can help relieve pain. Caffeine may also help for some people, although it may be a trigger for others.

Treatment plans are tailored to meet each individual’s needs. People can better manage their migraines with proper care.

Aftercare

A series of follow up visits help to evaluate the migraine treatment plan. People can continue tracking symptoms in a headache journal on their own to identify (and avoid) possible triggers in the future. A headache diary can also be helpful to show which treatments are more effective than others.